Warts, what an ugly word. At some point, everyone is plagued by a wart. If you are lucky, your warts will go away without any treatment. This is what often occurs in children.  Warts are caused by a virus, a strain of the human papilloma virus. The wart virus is everywhere in the environment, so it is pretty easy to catch one. All it takes is a little break in the skin and the wart virus can get in and take residence. Warts can infect any area of skin, but they tend to stick around on the hands and feet for a couple of reasons. First- the skin is thick and they can dig in the thick dead layer of skin (called the stratum corneum) without triggering the immune system. Second, the immune system is less vigilant in the extremities- so the warts can go less noticed.

So what should you do if you have a wart. First off, there is no easy or quick fix to a wart. All treatments take time and persistence. There are many over-the-counter wart treatments that all generally consist of a variable concentration of salicylic acid (Compound W is a popular one).  You put the acid on the wart and over time the acid both destroys the skin that the wart is living in and creates an immune response. All wart treatments work on this principal. Home wart treatment has been shown in studies to be just as effective as in-office, you just need to continue treatment until the wart is gone (and this can take months).

At the doctor’s office we can use liquid nitrogen and freeze the wart, but again this usually takes multiple treatments, and is usually painful both at the time of treatment and after (because there is a blister). Be careful using the drugstore liquid nitrogen, often it isn’t powerful enough to treat the wart but can cause scars. Other (doctor office) treatments that can be used for warts include cantharadin (also called beetle juice), candida antigen and bleomycin.  And don’t forget duct tape- this works by macerating (suffocating the skin) and causing an irritant dermatitis- similar to the way salicylic acid works.

So next time you get a wart, remember that treatment may take time. In adults it is best to start treatment early because they usually don’t resolve by themselves, in kids they might go away- so you can watch and wait.

To prevent getting a wart, wear your shoes in the locker room, pool and common shower area. In yoga, try to use your own mat and wear socks until you are on your mat.


Age Spots

Age spots, those sneaky brown spots that show up on your face, hands, arms and chest. The medical term for age spots is a solar lentigo. They are caused by the sun and appear in sun exposed areas. In most cases they are not harmful, though there is a type of melanoma (called lentigo maligna melanoma) that can look similar to an age spot- so if you notice dramatic changes (in color, size or shape) of your age spots please have them evaluated.

Now the real question- how can you get rid of them and how can you prevent them?

Prevention: these buggers are VERY sun sensitive. Sunscreen will not prevent these from popping up. You need to wear a hat and avoid sun exposure if you want to have NO sun spots.  Of course, sunscreen will help, but you need to make sure to reapply every 2-4 hours because it stops working in that time period.

Getting rid of them. It is not easy or quick. The least expensive and least invasive treatment is to use a cream that contains a lightening agent. The most effective lightening cream is hydroquinone and it works best when paired with retin-A. There are several non hydroquinone lighteners with variable results, they often contain Kojic Acid, vitamin C, azelaic acid, soy or a combination of these.

The next level of treatment is a chemical peel- these can be very effective and cost about $150-$300 per treatment. I love peels, they are a good bang for your buck. The downside is you will peel- so be prepared for 3-7 days of peeling. The peeling starts on day 2-3 after the peel. I always get my peels on Wednesday so I peel the most on Saturday and Sunday.

The most expensive and invasive treatment is a laser treatment. There are several types of lasers that can be used: Intense Pulsed Light, Fraxel, Carbon Dioxide (these are general categories listed in order of intensity and expense). If you want dramatic results you may need a laser.

All of the treatments cause your skin to be sensitive to the sun, so you MUST protect your investment or the sun damage will come back and might even be worse. Always wear at least SPF 30 and take a hat if you will be in direct sun.




Acne. The dreaded acne. Acne is common, but that doesn’t mean that you have to deal with having pimples on your face. My goal in treating your acne is that you have a completely clear face. Acne affects nearly 100% of people at some point in time in their life. It is a myth that only teenagers get acne. One of the more distressed group of patients are 25-40 year old females with acne (and rightfully so) .

So what can you do if you find yourself breaking out? If your acne is mild (just a few pimples), start with a wash that contains 2% salicylic acid or 10% Benzoyl peroxide. Also pick up a gel or lotion with Benzoyl peroxide. Use the wash every day and the gel/lotion every other day- because it can be drying. There are lots of drugstore brands that have these active ingredients. Be careful not to combine too many products with these medications because you might dry and irritate your skin. You can still use makeup and other products but be sure to look for ones that are non comedogenic (which means won’t clog pores).

It may take a few weeks for your skin to clear up, so don’t give up on the medications. When your skin clears up keep using the wash to help prevent it from coming back.

If you have deep, painful or really bad acne see your doctor or a dermatologist- you may need prescription medications. It is important to treat more severe acne early so you don’t get scarring. Oh- and don’t use tanning or the sun for acne treatment. It will clear things in the short run but it can cause more acne (and skin cancer and wrinkles) in the long run